Original ArticlesValue of Procalcitonin Measurement for Early Evidence of Severe Bacterial Infections in the Pediatric Intensive Care Unit
Section snippets
Methods
We performed a retrospective, observational study of all patients ages 29 days to 21 years admitted to a 55-bed PICU at an academic medical center between August 1, 2012, and February 15, 2014. Patients were included if blood PCT was sent as part of routine care within 48 hours of PICU admission, and the maximum measured PCT within this timeframe was used. For patients with multiple PICU admissions, only data from the first episode were included. We also excluded patients with superficial (ie,
Results
Of the 5521 PICU admissions within the study period, 667 patients met initial inclusion criteria. Twenty-one patients underwent full chart review but subsequently were excluded following determination of noninvasive (superficial) bacterial infections,18 leaving 646 patients for the final analysis (Figure 1; available at www.jpeds.com).
Patients were categorized as having no infection (n = 188), viral infection (n = 162), suspected bacterial infection without shock (n = 89), documented bacterial
Discussion
PCT in critically ill patients is more likely to be used as a guide to discontinue unnecessary empiric antibiotics in the absence of a microbiologically proven bacterial infection than as a diagnostic biomarker to initiate antibiotic therapy. Nonetheless, a clear understanding of the test characteristics of PCT and scenarios prone to false interpretation of results is necessary to optimize use of PCT in critically ill children. In this relatively large study of PCT in critically ill children,
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2022, Infectious Disease Clinics of North AmericaCitation Excerpt :However, there is considerable overlap in the clinical presentation of infectious and noninfectious etiologies of fever, shock, and multi-organ failure in critically ill children. No single symptom, test, or biomarker can reliably distinguish the 2.37–40 Due to this uncertainty, clinicians understandably may choose to start or continue antibiotic therapy without definitive evidence of bacterial infection.41
Utility of specific laboratory biomarkers to predict severe sepsis in pediatric patients with SIRS
2021, American Journal of Emergency MedicineCitation Excerpt :A variety of serum biomarkers have been utilized to help clinicians make this important distinction. Some biomarkers, such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), are non-specific markers of inflammation [22]. Others, such as procalcitonin may be more specific for the presence of bacterial infection [23].
The diagnostic value of serum C-reactive protein, procalcitonin, interleukin-6 and lactate dehydrogenase in patients with severe acute pancreatitis
2020, Clinica Chimica ActaCitation Excerpt :In the current study, serum concentrations of IL-6, PCT and CRP were significantly increased in more severe chronic spontaneous urticaria as compared with the healthy subjects and patients with mild disease, higher PCT level can be observed in local infections [32,33]. In our study, ROC curve was adopted to analyze the respective capability of CRP, IL-6 and PCT in the differential diagnosis of AP, and the AUC obtained was 0.637, 0.886 and 0.929, it indicated that PCT was not clinically useful enough to identify patients with localized infection, while it was the most valuable biomarker for severe infectious diseases [34,35]. It was reported that gestational diabetes, inflammation, intracranial hemorrhage, resuscitation, pneumothorax and other conditions can induce PCT elevation, especially those diseases combine with bacterial infection [36].
Biomarker Panels in Critical Care
2020, Critical Care ClinicsCitation Excerpt :Although individual biomarkers remain integral to the practice of critical care, single measurements are unlikely to fully capture the biological complexity of critical illness to an extent that decreases their clinical utility. Procalcitonin (PCT), for example, has shown clinical utility in guiding antibiotic usage in the setting of lower respiratory tract infections,8,9 but its predictive and prognostic capacity in sepsis is controversial.10–13 Among other factors, interpretation of PCT is complicated by confounders affecting its concentration other than presence of infection.
Supported by the Division of Critical Care Medicine at The Children's Hospital of Philadelphia. S.W. is supported by National Institute of General Medical Sciences (K23GM110496). The authors declare no conflicts of interest.